Intra-operative variations of Gastrocolic Trunk of Henle in patients undergoing Gastric, Pancreatic and Right Colonic Surgery

Introduction: Gastrointestinal Surgeons during dissection of infra-pancreatic portion of Superior Mesenteric Vein(SMV) encounter venous tributaries from head of pancreas, distal stomach and right colon draining separately or by forming Gastrocolic Trunk of Henle(GTH). Injury to these fragile veins may lead to profuse bleeding, increase operative-time and most importantly poor postoperative outcome. Meticulous dissection of this area is imperative for which detailed anatomical knowledge is essential. Methods: Our study is a prospective observational study done over a period of 18 months from August 2022 to January 2024 among the patients who underwent pancreatic, gastric and right colonic surgery which mandated dissection of infra-pancreatic portion of SMV. Meticulous dissection of this area was done and prevalence of GTH and its variations were identified and classifiedaccording to proposed classifications. Results: Among the forty-eight patients included in the study during the study period, GTH was present in thirty-seven(77.1%) patients. On the basis of classification proposed by Lange et al. GPCT type of GTH was present in nineteen(51.35%), GPT type in eleven(29.72%) patients and GCT type inseven(18.92%) patients. On the basis of Miyazawa classification eleven(29.73%) patients had Type 0 GTH, seventeen(45.95%) patients had Type 1 GTH, seven(18.92%) patients had Type 2 GTH and two(5.4%) patients had Type 3 GTH. On basis of Negoi classification, eight(21.62%) patients had Type 1 GTH, eleven(29.73%) patients had Type 2 GTH, four(10.81%) patients had Type 3 GTH,nine(24.32%) patients had Type 4 GTH, two(5.4%) patients had Type 5 GTH and three (8.1%) patients had Type 6 GTH. Conclusion: Understanding the anatomy of GTH is imperative for surgeons performing gastric, pancreatic and right colonic surgery. The prevalence of GTH and its subtypes is highly variable. Further studies are needed to understand its anatomy.